1152: Alpha-1 Receptor Blocking Therapy for Lower Ureteral Stones: A Randomized Prospective Trial

Tekın, Ali; Alkan, Erdal; Beysel, Melih; Yücebaş, Ergin; Aslan, Rüknettin; Şengör, Feridun

doi:10.1016/s0022-5347(18)38389-7

Cited by 16 publications

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“…34 38 Although tamsulosin was the most common intervention (40 studies), 10 37 41 42 55 naftopidil (three), 50 65 70 silodosin (six), 64 71 78 79 80 82 and terazosin (four). 31 34 36 46 The duration of follow-up varied across studies from seven to 42 days, with 28 days being the most common (37), 10 81 82 In three studies, corticosteroids were given to the intervention and/or control groups. 30 65 68 The baseline rate of stone passage without treatment with an alpha blocker varied across countries (fig A in appendix 3), at 7% in Thailand, 14% in Sri Lanka, 80% in the UK, and 82% in Australia.…”

Section: Search Strategy Resultsmentioning

confidence: 99%

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Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis

Hollingsworth

Canales

Rogers

et al. 2016

BMJ

112

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Objective To investigate the efficacy and safety of alpha blockers in the treatment of patients with ureteric stones.Design Systematic review and meta-analysis.Data sources Cochrane Central Register of Controlled Trials, Web of Science, Embase, LILACS, and Medline databases and scientific meeting abstracts to July 2016.Review methods Randomized controlled trials of alpha blockers compared with placebo or control for treatment of ureteric stones were eligible.Two team members independently extracted data from each included study. The primary outcome was the proportion of patients who passed their stone. Secondary outcomes were the time to passage; the number of pain episodes; and the proportions of patients who underwent surgery, required admission to hospital, and experienced an adverse event. Pooled risk ratios and 95% confidence intervals were calculated for the primary outcome with profile likelihood random effects models. Cochrane Collaboration’s tool for assessing risk of bias and the GRADE approach were used to evaluate the quality of evidence and summarize conclusions.Results 55 randomized controlled trials were included. There was moderate quality evidence that alpha blockers facilitate passage of ureteric stones (risk ratio 1.49, 95% confidence interval 1.39 to 1.61). Based on a priori subgroup analysis, there seemed to be no benefit to treatment with alpha blocker among patients with smaller ureteric stones (1.19, 1.00 to 1.48). Patients with larger stones treated with an alpha blocker, however, had a 57% higher risk of stone passage compared with controls (1.57, 1.17 to 2.27). The effect of alpha blockers was independent of stone location (1.48 (1.05 to 2.10) for upper or middle stones; 1.49 (1.38 to 1.63) for lower stones). Compared with controls, patients who received alpha blockers had significantly shorter times to stone passage (mean difference −3.79 days, −4.45 to −3.14; moderate quality evidence), fewer episodes of pain (−0.74 episodes, −1.28 to −0.21; low quality evidence), lower risks of surgical intervention (risk ratio 0.44, 0.37 to 0.52; moderate quality evidence), and lower risks of admission to hospital (0.37, 0.22 to 0.64; moderate quality evidence). The risk of a serious adverse event was similar between treatment and control groups (1.49, 0.24 to 9.35; low quality evidence).Conclusions Alpha blockers seem efficacious in the treatment of patients with ureteric stones who are amenable to conservative management. The greatest benefit might be among those with larger stones. These results support current guideline recommendations advocating a role for alpha blockers in patients with ureteric stones.Systematic review registration PROSPERO registration No CRD42015024169.

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Section: Search Strategy Resultsmentioning

confidence: 99%

“…30 31 36 37 40-45 47 51 53-56 58-69 71 72 74 76-79 81 or until stone passage. Placebo controls were used in 14 studies.…”

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confidence: 99%

Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis

Hollingsworth

Canales

Rogers

et al. 2016

BMJ

112

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“…In that trial, the average time to stone passage was not reported, the similar passage rates may be related to the longer treatment duration of 42 days, approaching the time when stone passage would spontaneously occur. A similar 28 day trial, conducted by Dellabella et al, analyzed not only expulsion rates, but also hospitalization and ureteroscopy rates in comparing the efficacy of tamsulosin with that of the antispasmodic agent phloroglucinol [21]. Both groups also received deflazacort 30 mg daily for up to 10 days and TMP/ SMX (80/400 mg) twice daily for 8 days.…”

Section: Discussionmentioning

confidence: 99%

Determine the Effectiveness of Low Dose Tamsulosin as a Medical Expulsive Therapy in Patients with Lower Ureteric Stones

Jatoi¹,

Altaf²,

Mahesar³

2017

J Biomedical Sci

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“…Tekin et al 21 described preliminary data on the efficacy of the α 1 -adrenoreceptor antagonist terazosin for distal ureteral stones. The passage rate was significantly higher with terazosin than with symptomatic treatment.…”

Section: α α 1 -Adrenoreceptor Antagonist Trialšmentioning

confidence: 99%

Pharmacologic Expulsive Treatment of Ureteral Calculi

Beach

Mauro

2006

Ann Pharmacother

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1152: Alpha-1 Receptor Blocking Therapy for Lower Ureteral Stones: A Randomized Prospective Trial

Cited by 16 publications

References 0 publications

Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis

Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis

Determine the Effectiveness of Low Dose Tamsulosin as a Medical Expulsive Therapy in Patients with Lower Ureteric Stones

Pharmacologic Expulsive Treatment of Ureteral Calculi

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